Trouble Sleeping? Join the Club!

Maybe I’m just lucky. I have no trouble sleeping! But there’s a lot of evidence that many Americans do.

According to a National Institutes of Health State-of-the-Science Conference in June 2005, about 30 percent of the adult population complains of sleep disruption, and about 10 percent have problems with daytime functioning. And the National Sleep Foundation’s 2005 annual poll found that while 49 percent of surveyed adults report having a “good night’s sleep” nearly every night, 24 percent reported having good sleep just a few nights a week, and 26 percent said they only got a good night’s sleep a few nights a month.

It should come as no surprise, then, that 42 million sleeping pill prescriptions were filled in 2005, up 60 percent since 2000, according to the health market research firm IMS Health.

What’s keeping people awake? Most cases of insomnia are associated with other medical problems, particularly with psychiatric disorders like depression or substance abuse, heart and lung diseases that compromise breathing, and many chronic illnesses associated with muscle or bone pain such as rheumatoid arthritis or chronic low back pain. Other conditions associated with insomnia are sleep apnea and restless leg syndrome.

It’s also known that the older you are, the more sleep difficulty you may experience. Whether this is because of illness or just age is unknown. Most studies have found a higher prevalence of insomnia in women, especially after menopause. Other contributing factors: cigarette smoking, alcohol and coffee consumption and certain drugs, both prescription and over-the-counter (e.g., many cold remedies contain pseudoephedrine, a stimulant).

Because there are so many potential causes for insomnia, you should be completely evaluated for treatable causes by a thorough physician if you have sleeping problems that have lasted for 30 days or more (that’s the definition of chronic insomnia). It’s possible that proper treatment of a medical condition, or a change in lifestyle, might lead to significant improvement in your sleep.

So what can you do if sleep is elusive and your doctor can’t pinpoint a medical cause?

Well, if you watch much TV or read most any magazines, you’ll probably be quite familiar with prescription drugs for insomnia, including Ambien (zolpidem) and Lunesta (eszopiclone). Another less advertised product is called Rozerem (ramelteon), and there may soon be another highly promoted pill, called Indiplon, which could be approved by the FDA in May (to be marketed by Pfizer). You may have also tried over-the-counter medicines like Sominex (all such OTC sleep medicines contain diphenhydramine, an antihistamine that causes sleepiness in many people as a side effect).

Recently, however, there has been a spate of news reports describing unusual behaviors in people taking Ambien. People have experienced sleep-walking, sleep-driving, sleep-eating, and even sleep-sex, all with no recollection of any of the events. In some cases, the activities have occurred in association with alcohol consumption, which is not recommended for people taking sleeping pills. In some cases, people have engaged in bizarre behavior the next morning (while awake), have had car accidents or felt groggy. So far, the articles have focused on Ambien, while Lunesta seems to be off-the-hook, at least for now.

So you might want to look into behavioral or cognitive-behavioral treatments. Behavioral methods include mind and body relaxation techniques. More recently, behavioral methods have been combined with cognitive psychotherapy in which you learn ways of mentally dealing with stress, anxiety and belief systems you may have related to sleep.

In fact, some studies have found that cognitive-behavioral treatments are at least as effective as prescription medications and the beneficial effects may last well beyond the active therapy (as opposed to medications that only work when you take them).

Other possibilities include yoga and tai-chi, both of which promote relaxation as well as movement.

Everyone is different and each person will need to figure out what’s best for them. Prescription drug therapy may be the easiest method for you and your doctor, but it may just be putting a band-aid on your problem. If you give a person a pill, they may sleep through the night, but if you teach them how to sleep, they may have more lasting, less expensive results. Then again, maybe they won’t â€“ everyone is different!

Do you have insomnia stories or tips for others on how to get a good night’s sleep? Have you experienced, or know of someone who has experienced strange behaviors after taking Ambien? Post them to this blog and share them with our readers. We look forward to hearing from you.
(Conflict of interest disclosure: HealthTalk and/or its sister companies have done work for Sanofi-Aventis [maker of Ambien] and for Sepracor [maker of Lunesta].)

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ABOUT THE AUTHOR

Ed Zimney, MD

Ed is a physician with more than 30 years of experience. He’s held positions in drug advertising review, drug safety surveillance, medical information and marketing with several bio/pharmaceutical companies.